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Assignment Prompt & Instructions

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**files (3)**

– ## ProjectProposalDraftRubric.pdf

– ## ProjectProposalTemplatewithPDSAWorksheetWord.docx

– ## Proposaldraft.docx

**## ProjectProposalDraftRubric.pdf**

© Summer 2026
MSUM SNHL

Nursing 473: Project Proposal Draft Rubric

Following the guidelines in the proposal template and the IHI Open School modules:

Criterion Document Points Earned

Assessment and
Identification of the
Problem/Need

• Issue that led to identification of
your project topic

• Main purpose of your project
• Currently informed by best

evidence

/2

Planning

• Project Title
• Personal Opportunity Statement
• Aim
• Outcome Measure
• Process Measures
• Balancing Measures
• Change to Test
• Strategy Timeline

/8

TOTAL /10

– Nursing 473: Project Proposal Draft Rubric
– Assessment and Identification of the Problem/Need
– Planning

**## ProjectProposalTemplatewithPDSAWorksheetWord.docx**


## Nursing 473: Professional Pathways Template for Project Proposal with PDSA Worksheet

**Assessment and Identification of the Problem/Need**

·
**Pathways Proposal Topic**

· In one paragraph, discuss the issue(s) or problem(s) that led to the identification of your project topic or focus.

· Based on this, what is the main purpose of your project?

**Planning**

·
**The nursing/leadership/change theory or model that will guide your project:** IHI Model for Improvement with PDSA Cycle

·
**Choose ONE key QSEN competency/competencies which will be addressed by this project:**

·
**Student Name:**

·
**Site(s) for project implementation after successful course completion:**

**Project Title:**

© Summer 2026

MSUM SNHL

| |
| — |
| **Personal Opportunity Statement:**<br>_Example: I’d like to become a really good runner._ |
| · <br>**Overarching Project Goal (THINK BIG):**<br>For further guidance on how to develop your aim statement and family of measures, please reference the IHI Model for Improvement website.<br> <br>· <br>**Aim Statement(s):**<br>State what you are trying to accomplish, including: How good? By when? For whom?<br>_Example: 5 weeks from today, I will be able to run 5.3 miles in 50 minutes._ |

·
**Measures**

_For the family of measures, please include the unit of measurement (a percent or number). Example: The percent of nurses that attend the educational training._

·
**Outcome Measure:**

List the measure(s) you ultimately want to affect.

_Example: The number of miles I can run in 50 minutes._

·
**Process Measures:**

List the measures that will tell you if the parts or steps in the system are performing as planned to affect the outcome measure.

1.

2.

3.

_Example: 1) Minutes runs per week 2) Minutes of strength training per week_

·
**Balancing Measures:**

List the measures you will track to determine whether you are introducing problems in other parts of the system.

1.

2.

3.

_Example: 1) Hours slept per night 2) Daily productivity at work on a scale of 1–5_

·
**Changes to Test:**

State how you will achieve your aim (i.e., what changes do you believe will lead to the improvement?).

1.

2.

3.

_Example: Leave work by 5:30 PM._

_· Specify_
_**activities/strategies** to MEET you goal and aims (what are the steps)? List EACH step that will be required to get your project up and running (include research, planning steps, implementation, and evaluation – make this specific enough so that someone else would be able to step in at any point and take over). Add rows as you go…_

_| | | | |_
_| — | — | — | — |_
_| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |_
_| | | | |_
_| | | | |_
_| | | | |_

_**image1.png**_

**## Proposaldraft.docx**

**Nursing 473: Project Proposal**

Reducing Secondary Falls and Improving Functional Recovery After Hip Fracture

**Assessment and Identification of the Problem/Need**

**_Issue that led to identification of your project topic:_**

On our inpatient rehabilitation unit, informal conversations with nurses and physical therapists surfaced a shared concern: patients recovering from hip fracture surgery were routinely discharged with non-individualized activity instructions rather than a structured home exercise plan. A review of discharge documentation confirmed this impression, showing inconsistent exercise teaching across patients, with some receiving only a printed handout and others receiving no instructions at all. This gap is clinically significant because many patients who fall once are readmitted within months due to a repeat fall, and the absence of a standardized, evidence-based exercise pathway leaves a preventable risk unaddressed at the point of discharge.

**_Main purpose of your project:_**

The purpose of this project is to design a nurse-led, multicomponent exercise rehabilitation pathway for patients discharged from the unit after hip fracture surgery, in order to reduce secondary falls and improve functional mobility during the post-discharge recovery period.

**_Currently informed by best evidence:_**

The project is grounded in a synthesis of current literature, including systematic reviews and randomized controlled trials showing that multicomponent, home-based exercise rehabilitation (strength, balance, and functional training) improves mobility outcomes more consistently than single-element programs (Lee & Lee, 2022; Pantouvaki et al., 2023). It further draws on evidence that caregiver involvement and structured follow-up improve adherence and reduce fear of falling (Prieto-Moreno et al., 2024, 2025), and that coordinated discharge planning and orthogeriatric co-management are associated with better long-term outcomes than fragmented care (Dakhil et al., 2021; Rocha et al., 2024).

**Planning**

**_Nursing/leadership/change theory or model guiding this project:_**

IHI Model for Improvement, using the Plan-Do-Study-Act (PDSA) cycle.

**_Primary QSEN Competency addressed:_**

Quality Improvement — using data on screening rates, exercise adherence, and mobility scores to test and refine practice changes.

**_Project Title:_**

Nurse-Led Exercise Rehabilitation Pathway to Reduce Secondary Falls After Hip Fracture

**_Personal Opportunity Statement:_**

I would like to help adult post hip fracture surgery patients on my unit leave the hospital with a clear, individualized plan for regaining strength and mobility, rather than generic advice that leaves them vulnerable to another fall.

**_Overarching Project Goal (THINK BIG):_**

Reduce secondary falls and improve functional mobility among patients discharged after hip fracture surgery.

**_Aim Statement:_**

Within six months of implementation, at least 90% of hip fracture patients on the unit will receive a standardized fall-risk and mobility screening at admission and an individualized exercise plan prior to discharge, with the goal of reducing 30-day secondary fall/readmission rates and improved functional mobility between discharge and 30-day follow-up.

**Measures**

**_Outcome Measure(s):_**

Rate of secondary falls or fall-related readmissions within 30 days of discharge.

Change in functional mobility score between discharge and 30-day follow-up.

**_Process Measures:_**

Percentage of patients who receive a fall-risk and mobility screening (TUG, Morse Fall Scale) at admission.

Percentage of patients/caregivers who receive the exercise handout and discharge teaching prior to discharge.

Percentage of patients/caregivers reached for the 2-week follow-up call.

**_Balancing Measures:_**

Nursing time spent on screening and follow-up calls, to monitor added workload burden.

Patient/caregiver-reported difficulty completing the exercise program (assessed at follow-up call).

**_Changes to Test:_**

Introduce a brief fall-risk and mobility screening (TUG, Morse Fall Scale) at admission for all hip fracture patients.

Provide a standardized, multilingual exercise handout and caregiver-inclusive teaching prior to discharge.

Conduct a follow-up phone call approximately two weeks post-discharge to assess adherence and troubleshoot barriers.

**Strategy Timeline**

Specify each step required to plan, implement, and evaluate the project:

| | | | |
| — | — | — | — |
| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |
| Present proposal and obtain approval from unit management and physical therapy | Inpatient rehab unit | Unit manager, PT lead, project lead (RN) | Week 1 |
| Develop/finalize screening tool, exercise handout, and discharge checklist | Unit / office | Project lead, PT team, charge nurse | Weeks 2–3 |
| Train nursing staff on screening tool, exercise handout, and follow-up call protocol | Inpatient rehab unit | All unit nursing staff, project lead | Week 4 |
| Pilot PDSA cycle 1: implement screening + exercise teaching with a small group of patients | Inpatient rehab unit | Nursing staff, patients/caregivers | Weeks 5–8 |
| Conduct 2-week follow-up calls; collect process and balancing measure data | Phone / remote | Nursing staff, patients/caregivers | Weeks 6–11 |
| Expand to full unit if outcomes support it; begin 6-month outcome tracking | Inpatient rehab unit | All unit staff, project lead | Month 3–6 |

**## Proposaldraft.docx**

**Nursing 473: Project Proposal**

Reducing Secondary Falls and Improving Functional Recovery After Hip Fracture

**Assessment and Identification of the Problem/Need**

**_Issue that led to identification of your project topic:_**

On our inpatient rehabilitation unit, informal conversations with nurses and physical therapists surfaced a shared concern: patients recovering from hip fracture surgery were routinely discharged with non-individualized activity instructions rather than a structured home exercise plan. A review of discharge documentation confirmed this impression, showing inconsistent exercise teaching across patients, with some receiving only a printed handout and others receiving no instructions at all. This gap is clinically significant because many patients who fall once are readmitted within months due to a repeat fall, and the absence of a standardized, evidence-based exercise pathway leaves a preventable risk unaddressed at the point of discharge.

**_Main purpose of your project:_**

The purpose of this project is to design a nurse-led, multicomponent exercise rehabilitation pathway for patients discharged from the unit after hip fracture surgery, in order to reduce secondary falls and improve functional mobility during the post-discharge recovery period.

**_Currently informed by best evidence:_**

The project is grounded in a synthesis of current literature, including systematic reviews and randomized controlled trials showing that multicomponent, home-based exercise rehabilitation (strength, balance, and functional training) improves mobility outcomes more consistently than single-element programs (Lee & Lee, 2022; Pantouvaki et al., 2023). It further draws on evidence that caregiver involvement and structured follow-up improve adherence and reduce fear of falling (Prieto-Moreno et al., 2024, 2025), and that coordinated discharge planning and orthogeriatric co-management are associated with better long-term outcomes than fragmented care (Dakhil et al., 2021; Rocha et al., 2024).

**Planning**

**_Nursing/leadership/change theory or model guiding this project:_**

IHI Model for Improvement, using the Plan-Do-Study-Act (PDSA) cycle.

**_Primary QSEN Competency addressed:_**

Quality Improvement — using data on screening rates, exercise adherence, and mobility scores to test and refine practice changes.

**_Project Title:_**

Nurse-Led Exercise Rehabilitation Pathway to Reduce Secondary Falls After Hip Fracture

**_Personal Opportunity Statement:_**

I would like to help adult post hip fracture surgery patients on my unit leave the hospital with a clear, individualized plan for regaining strength and mobility, rather than generic advice that leaves them vulnerable to another fall.

**_Overarching Project Goal (THINK BIG):_**

Reduce secondary falls and improve functional mobility among patients discharged after hip fracture surgery.

**_Aim Statement:_**

Within six months of implementation, at least 90% of hip fracture patients on the unit will receive a standardized fall-risk and mobility screening at admission and an individualized exercise plan prior to discharge, with the goal of reducing 30-day secondary fall/readmission rates and improved functional mobility between discharge and 30-day follow-up.

**Measures**

**_Outcome Measure(s):_**

Rate of secondary falls or fall-related readmissions within 30 days of discharge.

Change in functional mobility score between discharge and 30-day follow-up.

**_Process Measures:_**

Percentage of patients who receive a fall-risk and mobility screening (TUG, Morse Fall Scale) at admission.

Percentage of patients/caregivers who receive the exercise handout and discharge teaching prior to discharge.

Percentage of patients/caregivers reached for the 2-week follow-up call.

**_Balancing Measures:_**

Nursing time spent on screening and follow-up calls, to monitor added workload burden.

Patient/caregiver-reported difficulty completing the exercise program (assessed at follow-up call).

**_Changes to Test:_**

Introduce a brief fall-risk and mobility screening (TUG, Morse Fall Scale) at admission for all hip fracture patients.

Provide a standardized, multilingual exercise handout and caregiver-inclusive teaching prior to discharge.

Conduct a follow-up phone call approximately two weeks post-discharge to assess adherence and troubleshoot barriers.

**Strategy Timeline**

Specify each step required to plan, implement, and evaluate the project:

| | | | |
| — | — | — | — |
| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |
| Present proposal and obtain approval from unit management and physical therapy | Inpatient rehab unit | Unit manager, PT lead, project lead (RN) | Week 1 |
| Develop/finalize screening tool, exercise handout, and discharge checklist | Unit / office | Project lead, PT team, charge nurse | Weeks 2–3 |
| Train nursing staff on screening tool, exercise handout, and follow-up call protocol | Inpatient rehab unit | All unit nursing staff, project lead | Week 4 |
| Pilot PDSA cycle 1: implement screening + exercise teaching with a small group of patients | Inpatient rehab unit | Nursing staff, patients/caregivers | Weeks 5–8 |
| Conduct 2-week follow-up calls; collect process and balancing measure data | Phone / remote | Nursing staff, patients/caregivers | Weeks 6–11 |
| Expand to full unit if outcomes support it; begin 6-month outcome tracking | Inpatient rehab unit | All unit staff, project lead | Month 3–6 |

**## ProjectProposalDraftRubric.pdf**

© Summer 2026
MSUM SNHL

Nursing 473: Project Proposal Draft Rubric

Following the guidelines in the proposal template and the IHI Open School modules:

Criterion Document Points Earned

Assessment and
Identification of the
Problem/Need

• Issue that led to identification of
your project topic

• Main purpose of your project
• Currently informed by best

evidence

/2

Planning

• Project Title
• Personal Opportunity Statement
• Aim
• Outcome Measure
• Process Measures
• Balancing Measures
• Change to Test
• Strategy Timeline

/8

TOTAL /10

– Nursing 473: Project Proposal Draft Rubric
– Assessment and Identification of the Problem/Need
– Planning

**## ProjectProposalTemplatewithPDSAWorksheetWord.docx**


## Nursing 473: Professional Pathways Template for Project Proposal with PDSA Worksheet

**Assessment and Identification of the Problem/Need**

·
**Pathways Proposal Topic**

· In one paragraph, discuss the issue(s) or problem(s) that led to the identification of your project topic or focus.

· Based on this, what is the main purpose of your project?

**Planning**

·
**The nursing/leadership/change theory or model that will guide your project:** IHI Model for Improvement with PDSA Cycle

·
**Choose ONE key QSEN competency/competencies which will be addressed by this project:**

·
**Student Name:**

·
**Site(s) for project implementation after successful course completion:**

**Project Title:**

© Summer 2026

MSUM SNHL

| |
| — |
| **Personal Opportunity Statement:**<br>_Example: I’d like to become a really good runner._ |
| · <br>**Overarching Project Goal (THINK BIG):**<br>For further guidance on how to develop your aim statement and family of measures, please reference the IHI Model for Improvement website.<br> <br>· <br>**Aim Statement(s):**<br>State what you are trying to accomplish, including: How good? By when? For whom?<br>_Example: 5 weeks from today, I will be able to run 5.3 miles in 50 minutes._ |

·
**Measures**

_For the family of measures, please include the unit of measurement (a percent or number). Example: The percent of nurses that attend the educational training._

·
**Outcome Measure:**

List the measure(s) you ultimately want to affect.

_Example: The number of miles I can run in 50 minutes._

·
**Process Measures:**

List the measures that will tell you if the parts or steps in the system are performing as planned to affect the outcome measure.

1.

2.

3.

_Example: 1) Minutes runs per week 2) Minutes of strength training per week_

·
**Balancing Measures:**

List the measures you will track to determine whether you are introducing problems in other parts of the system.

1.

2.

3.

_Example: 1) Hours slept per night 2) Daily productivity at work on a scale of 1–5_

·
**Changes to Test:**

State how you will achieve your aim (i.e., what changes do you believe will lead to the improvement?).

1.

2.

3.

_Example: Leave work by 5:30 PM._

_· Specify_
_**activities/strategies** to MEET you goal and aims (what are the steps)? List EACH step that will be required to get your project up and running (include research, planning steps, implementation, and evaluation – make this specific enough so that someone else would be able to step in at any point and take over). Add rows as you go…_

_| | | | |_
_| — | — | — | — |_
_| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |_
_| | | | |_
_| | | | |_
_| | | | |_

_**image1.png**_

**## Proposaldraft.docx**

**Nursing 473: Project Proposal**

Reducing Secondary Falls and Improving Functional Recovery After Hip Fracture

**Assessment and Identification of the Problem/Need**

**_Issue that led to identification of your project topic:_**

On our inpatient rehabilitation unit, informal conversations with nurses and physical therapists surfaced a shared concern: patients recovering from hip fracture surgery were routinely discharged with non-individualized activity instructions rather than a structured home exercise plan. A review of discharge documentation confirmed this impression, showing inconsistent exercise teaching across patients, with some receiving only a printed handout and others receiving no instructions at all. This gap is clinically significant because many patients who fall once are readmitted within months due to a repeat fall, and the absence of a standardized, evidence-based exercise pathway leaves a preventable risk unaddressed at the point of discharge.

**_Main purpose of your project:_**

The purpose of this project is to design a nurse-led, multicomponent exercise rehabilitation pathway for patients discharged from the unit after hip fracture surgery, in order to reduce secondary falls and improve functional mobility during the post-discharge recovery period.

**_Currently informed by best evidence:_**

The project is grounded in a synthesis of current literature, including systematic reviews and randomized controlled trials showing that multicomponent, home-based exercise rehabilitation (strength, balance, and functional training) improves mobility outcomes more consistently than single-element programs (Lee & Lee, 2022; Pantouvaki et al., 2023). It further draws on evidence that caregiver involvement and structured follow-up improve adherence and reduce fear of falling (Prieto-Moreno et al., 2024, 2025), and that coordinated discharge planning and orthogeriatric co-management are associated with better long-term outcomes than fragmented care (Dakhil et al., 2021; Rocha et al., 2024).

**Planning**

**_Nursing/leadership/change theory or model guiding this project:_**

IHI Model for Improvement, using the Plan-Do-Study-Act (PDSA) cycle.

**_Primary QSEN Competency addressed:_**

Quality Improvement — using data on screening rates, exercise adherence, and mobility scores to test and refine practice changes.

**_Project Title:_**

Nurse-Led Exercise Rehabilitation Pathway to Reduce Secondary Falls After Hip Fracture

**_Personal Opportunity Statement:_**

I would like to help adult post hip fracture surgery patients on my unit leave the hospital with a clear, individualized plan for regaining strength and mobility, rather than generic advice that leaves them vulnerable to another fall.

**_Overarching Project Goal (THINK BIG):_**

Reduce secondary falls and improve functional mobility among patients discharged after hip fracture surgery.

**_Aim Statement:_**

Within six months of implementation, at least 90% of hip fracture patients on the unit will receive a standardized fall-risk and mobility screening at admission and an individualized exercise plan prior to discharge, with the goal of reducing 30-day secondary fall/readmission rates and improved functional mobility between discharge and 30-day follow-up.

**Measures**

**_Outcome Measure(s):_**

Rate of secondary falls or fall-related readmissions within 30 days of discharge.

Change in functional mobility score between discharge and 30-day follow-up.

**_Process Measures:_**

Percentage of patients who receive a fall-risk and mobility screening (TUG, Morse Fall Scale) at admission.

Percentage of patients/caregivers who receive the exercise handout and discharge teaching prior to discharge.

Percentage of patients/caregivers reached for the 2-week follow-up call.

**_Balancing Measures:_**

Nursing time spent on screening and follow-up calls, to monitor added workload burden.

Patient/caregiver-reported difficulty completing the exercise program (assessed at follow-up call).

**_Changes to Test:_**

Introduce a brief fall-risk and mobility screening (TUG, Morse Fall Scale) at admission for all hip fracture patients.

Provide a standardized, multilingual exercise handout and caregiver-inclusive teaching prior to discharge.

Conduct a follow-up phone call approximately two weeks post-discharge to assess adherence and troubleshoot barriers.

**Strategy Timeline**

Specify each step required to plan, implement, and evaluate the project:

| | | | |
| — | — | — | — |
| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |
| Present proposal and obtain approval from unit management and physical therapy | Inpatient rehab unit | Unit manager, PT lead, project lead (RN) | Week 1 |
| Develop/finalize screening tool, exercise handout, and discharge checklist | Unit / office | Project lead, PT team, charge nurse | Weeks 2–3 |
| Train nursing staff on screening tool, exercise handout, and follow-up call protocol | Inpatient rehab unit | All unit nursing staff, project lead | Week 4 |
| Pilot PDSA cycle 1: implement screening + exercise teaching with a small group of patients | Inpatient rehab unit | Nursing staff, patients/caregivers | Weeks 5–8 |
| Conduct 2-week follow-up calls; collect process and balancing measure data | Phone / remote | Nursing staff, patients/caregivers | Weeks 6–11 |
| Expand to full unit if outcomes support it; begin 6-month outcome tracking | Inpatient rehab unit | All unit staff, project lead | Month 3–6 |

**## ProjectProposalDraftRubric.pdf**

© Summer 2026
MSUM SNHL

Nursing 473: Project Proposal Draft Rubric

Following the guidelines in the proposal template and the IHI Open School modules:

Criterion Document Points Earned

Assessment and
Identification of the
Problem/Need

• Issue that led to identification of
your project topic

• Main purpose of your project
• Currently informed by best

evidence

/2

Planning

• Project Title
• Personal Opportunity Statement
• Aim
• Outcome Measure
• Process Measures
• Balancing Measures
• Change to Test
• Strategy Timeline

/8

TOTAL /10

– Nursing 473: Project Proposal Draft Rubric
– Assessment and Identification of the Problem/Need
– Planning

**## ProjectProposalTemplatewithPDSAWorksheetWord.docx**


## Nursing 473: Professional Pathways Template for Project Proposal with PDSA Worksheet

**Assessment and Identification of the Problem/Need**

·
**Pathways Proposal Topic**

· In one paragraph, discuss the issue(s) or problem(s) that led to the identification of your project topic or focus.

· Based on this, what is the main purpose of your project?

**Planning**

·
**The nursing/leadership/change theory or model that will guide your project:** IHI Model for Improvement with PDSA Cycle

·
**Choose ONE key QSEN competency/competencies which will be addressed by this project:**

·
**Student Name:**

·
**Site(s) for project implementation after successful course completion:**

**Project Title:**

© Summer 2026

MSUM SNHL

| |
| — |
| **Personal Opportunity Statement:**<br>_Example: I’d like to become a really good runner._ |
| · <br>**Overarching Project Goal (THINK BIG):**<br>For further guidance on how to develop your aim statement and family of measures, please reference the IHI Model for Improvement website.<br> <br>· <br>**Aim Statement(s):**<br>State what you are trying to accomplish, including: How good? By when? For whom?<br>_Example: 5 weeks from today, I will be able to run 5.3 miles in 50 minutes._ |

·
**Measures**

_For the family of measures, please include the unit of measurement (a percent or number). Example: The percent of nurses that attend the educational training._

·
**Outcome Measure:**

List the measure(s) you ultimately want to affect.

_Example: The number of miles I can run in 50 minutes._

·
**Process Measures:**

List the measures that will tell you if the parts or steps in the system are performing as planned to affect the outcome measure.

1.

2.

3.

_Example: 1) Minutes runs per week 2) Minutes of strength training per week_

·
**Balancing Measures:**

List the measures you will track to determine whether you are introducing problems in other parts of the system.

1.

2.

3.

_Example: 1) Hours slept per night 2) Daily productivity at work on a scale of 1–5_

·
**Changes to Test:**

State how you will achieve your aim (i.e., what changes do you believe will lead to the improvement?).

1.

2.

3.

_Example: Leave work by 5:30 PM._

_· Specify_
_**activities/strategies** to MEET you goal and aims (what are the steps)? List EACH step that will be required to get your project up and running (include research, planning steps, implementation, and evaluation – make this specific enough so that someone else would be able to step in at any point and take over). Add rows as you go…_

_| | | | |_
_| — | — | — | — |_
_| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |_
_| | | | |_
_| | | | |_
_| | | | |_

_**image1.png**_

**## Proposaldraft.docx**

**Nursing 473: Project Proposal**

Reducing Secondary Falls and Improving Functional Recovery After Hip Fracture

**Assessment and Identification of the Problem/Need**

**_Issue that led to identification of your project topic:_**

On our inpatient rehabilitation unit, informal conversations with nurses and physical therapists surfaced a shared concern: patients recovering from hip fracture surgery were routinely discharged with non-individualized activity instructions rather than a structured home exercise plan. A review of discharge documentation confirmed this impression, showing inconsistent exercise teaching across patients, with some receiving only a printed handout and others receiving no instructions at all. This gap is clinically significant because many patients who fall once are readmitted within months due to a repeat fall, and the absence of a standardized, evidence-based exercise pathway leaves a preventable risk unaddressed at the point of discharge.

**_Main purpose of your project:_**

The purpose of this project is to design a nurse-led, multicomponent exercise rehabilitation pathway for patients discharged from the unit after hip fracture surgery, in order to reduce secondary falls and improve functional mobility during the post-discharge recovery period.

**_Currently informed by best evidence:_**

The project is grounded in a synthesis of current literature, including systematic reviews and randomized controlled trials showing that multicomponent, home-based exercise rehabilitation (strength, balance, and functional training) improves mobility outcomes more consistently than single-element programs (Lee & Lee, 2022; Pantouvaki et al., 2023). It further draws on evidence that caregiver involvement and structured follow-up improve adherence and reduce fear of falling (Prieto-Moreno et al., 2024, 2025), and that coordinated discharge planning and orthogeriatric co-management are associated with better long-term outcomes than fragmented care (Dakhil et al., 2021; Rocha et al., 2024).

**Planning**

**_Nursing/leadership/change theory or model guiding this project:_**

IHI Model for Improvement, using the Plan-Do-Study-Act (PDSA) cycle.

**_Primary QSEN Competency addressed:_**

Quality Improvement — using data on screening rates, exercise adherence, and mobility scores to test and refine practice changes.

**_Project Title:_**

Nurse-Led Exercise Rehabilitation Pathway to Reduce Secondary Falls After Hip Fracture

**_Personal Opportunity Statement:_**

I would like to help adult post hip fracture surgery patients on my unit leave the hospital with a clear, individualized plan for regaining strength and mobility, rather than generic advice that leaves them vulnerable to another fall.

**_Overarching Project Goal (THINK BIG):_**

Reduce secondary falls and improve functional mobility among patients discharged after hip fracture surgery.

**_Aim Statement:_**

Within six months of implementation, at least 90% of hip fracture patients on the unit will receive a standardized fall-risk and mobility screening at admission and an individualized exercise plan prior to discharge, with the goal of reducing 30-day secondary fall/readmission rates and improved functional mobility between discharge and 30-day follow-up.

**Measures**

**_Outcome Measure(s):_**

Rate of secondary falls or fall-related readmissions within 30 days of discharge.

Change in functional mobility score between discharge and 30-day follow-up.

**_Process Measures:_**

Percentage of patients who receive a fall-risk and mobility screening (TUG, Morse Fall Scale) at admission.

Percentage of patients/caregivers who receive the exercise handout and discharge teaching prior to discharge.

Percentage of patients/caregivers reached for the 2-week follow-up call.

**_Balancing Measures:_**

Nursing time spent on screening and follow-up calls, to monitor added workload burden.

Patient/caregiver-reported difficulty completing the exercise program (assessed at follow-up call).

**_Changes to Test:_**

Introduce a brief fall-risk and mobility screening (TUG, Morse Fall Scale) at admission for all hip fracture patients.

Provide a standardized, multilingual exercise handout and caregiver-inclusive teaching prior to discharge.

Conduct a follow-up phone call approximately two weeks post-discharge to assess adherence and troubleshoot barriers.

**Strategy Timeline**

Specify each step required to plan, implement, and evaluate the project:

| | | | |
| — | — | — | — |
| **Activity (what)** | **Site (where)** | **Participants (who)** | **Date** |
| Present proposal and obtain approval from unit management and physical therapy | Inpatient rehab unit | Unit manager, PT lead, project lead (RN) | Week 1 |
| Develop/finalize screening tool, exercise handout, and discharge checklist | Unit / office | Project lead, PT team, charge nurse | Weeks 2–3 |
| Train nursing staff on screening tool, exercise handout, and follow-up call protocol | Inpatient rehab unit | All unit nursing staff, project lead | Week 4 |
| Pilot PDSA cycle 1: implement screening + exercise teaching with a small group of patients | Inpatient rehab unit | Nursing staff, patients/caregivers | Weeks 5–8 |
| Conduct 2-week follow-up calls; collect process and balancing measure data | Phone / remote | Nursing staff, patients/caregivers | Weeks 6–11 |
| Expand to full unit if outcomes support it; begin 6-month outcome tracking | Inpatient rehab unit | All unit staff, project lead | Month 3–6 |